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NPI Code Detail

MEDICARE: STEPHANIE CARABALLO

MEDICARE: STEPHANIE CARABALLO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1629907563
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE CARABALLO
Provider Business Mailing Address
First Line : 2714 WALLACE HILL RD
Second Line :
City : WELLS RIVER
State : VT
Zip : 05081-9406
Country : US
Telephone Number : 516-660-4714
Fax Number :
Provider Business Practice Location Address
First Line : 1 MEDICAL CENTER DR
Second Line :
City : LEBANON
State : NH
Zip : 03756-0001
Country : US
Telephone Number : 603-650-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2026
Last Update Date : 05/18/2026

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Directions to “ STEPHANIE CARABALLO ” Practice Location

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